From Hypertension to Heart Failure课件.ppt

Hypertension and The Heart FDR’s Final Picture (April 11, 1945)  FDR’s BP as recorded April 1944 at Bethesda Naval Hospital  Progression From Hypertensionto Heart Failure Population-Attributable Risks for Development of CHF Effects of Hypertension on The Heart Left Ventricular Hypertrophy Vascular Disease: -Atherosclerosis -Arteriosclerosis Prevalence of Systolic and Diastolic Dysfunction by Age SYSTOLIC AND DIASTOLIC HEART FAILURE LOW EF HIGH LV MASS MYOCYTE HYPERTOPHY INTERSTITIAL FIBROSIS ABNORM CALC HANDLING REDUCED CONTRACTILITY SLOWED RELAXATION DEPLETED PREL0AD RESERVE LARGE VOLUMES NORMAL EF HIGH LV MASS MYOCYTE HYPERTROPHY INTERSTITIAL FIBROSIS ABNORM CALC HANDLING REDUCED CONTRACTILITY SLOWED RELAXATION DEPLETED PRELOAD RESERVE SMALL VOLUMES Left Ventricular Hypertrophy Independent Predictor of: Myocardial infarction Stroke Heart Failure Total Mortality Sudden Death LIFE: Design Dosing LIFE: Blood Pressure Results – Follow-up LIFE: Fatal/Nonfatal Stroke LIFE: Fatal/Nonfatal Myocardial Infarction LIFE: Cardiovascular Mortality LIFE: Other Classified Endpoints LVH Prevalence at Baseline and Annual Follow-Up in LIFE LIFE Echo Substudy: Change in LVMI Regression of Hypertensive LVH: Results of 2000 Meta-Analysis CHARM Programme CHARM-Preserved Primary and secondary outcomes Effects of Hypertension on The Heart Left Ventricular Hypertrophy Vascular Disease: -Atherosclerosis -Arteriosclerosis ATHERO- ARTERIO- SCLEROSIS SCLEROSIS (Increased vascular stiffness  Decreased vascular compliance) Focal, Occlusive Inflammatory Endothelial dysfunction Related to LDL cholesterol oxidation “Inside-out” Sensitive to A II and other substances Diffuse, Dilatory Fibrotic (elastin breakdown, collagen increase) Adventitial and medial hypertrophy Related to age and BP “Outside-in” Sensitive to A II and other substances Integrated Perspective on CV Risk Factors and Vascular Disease BP and Risk